摘要：

Section 3: Diagnosis / Differential Diagnosis / Investigations 1. In adolescents experiencing dysmenorrhea in the first 6 months from the start of menarche, and when an anovulatory patient complains of dysmenorrhea, the diagnosis of obstructing malformation of the genital tract should be considered. (III-A) 2. The diagnosis of secondary dysmenorrhea should be considered when symptoms appear after many years of painless menses. (III-A) 3. In view of the high prevalence of dysmenorrhea, and evidence that many women do not seek medical attention for this problem, health care providers should include specific questions regarding menstrual pain when obtaining a woman?s medical history. (III-B) 4. In an adolescent who has never been sexually active and has a typical history of mild to moderate dysmenorrhea, a pelvic examination is not necessary. (III-D) 5. A pelvic examination is indicated in all patients not responding to conventional therapy of dysmenorrhea or when an organic pathology is suspected. (III-B) Section 4: Non-medicinal Therapeutic Options 1. Unlike low-frequency TENS, high-frequency TENS provides more effective dysmenorrhea pain relief compared with placebo. High-frequency TENS may be considered as a supplementary treatment in women unable to tolerate medication. (II-B) 2. Women who inquire about alternatives to relieve dysmenorrhea, may be instructed that, at the present time, there is limited evidence that acupuncture may be of benefit (II-B), there is no evidence to support spinal manipulation as an effective treatment (II-D), and there is limited evidence to support topical heat therapy (II-B).

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